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COVID-19's Fourth Wave: What You Need to Know Now

With vaccine efforts accelerating, experts hope latest surge won't be like others

People walking in a park in New York City

Noam Galai/Getty Images

En español | After weeks of steady decline, COVID-19 cases and hospitalizations are creeping back up. The U.S. is seeing, on average, 63,000 new coronavirus infections each day — about the same amount recorded in mid-July during the summer surge, or second wave. And an increasing number of Americans are being admitted to hospitals for COVID-19 treatment.

While the climb in cases and hospitalizations may feel like déjà vu, health experts are hopeful that this “fourth wave” will be different from previous peaks in the pandemic.


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The main reason: The vaccines, which so far have proved highly effective at preventing severe COVID-19 illness, are making their way into millions of arms each day. “And that is likely to have an impact in terms of keeping hospitalizations and deaths under better control than previously,” says Shama Cash-Goldwasser, M.D., an infectious disease physician and a senior technical adviser in the Epidemic Intelligence Unit at Resolve to Save Lives.

Both hospitalizations and deaths saw the greatest swell in mid-January during the so-called third wave, when roughly 4,000 people died from COVID-19 each day. The current average hovers around 700 daily deaths, and experts expect to see that tally decline as more Americans get vaccinated.

Daily Trends in Numbers of COVID-19 Cases in the U.S.

U.S. Centers for Disease Control

For an interactive version of this chart, visit CDC.gov.

So far more than 64 million Americans have been fully vaccinated, and about 110 million Americans have received at least one dose of a two-dose series, federal data show. What's more, the majority of Americans 65 and older — the population most affected by serious illness and death from the virus — have been vaccinated. “That's a big difference now,” compared to previous COVID-19 waves, Cash-Goldwasser says.

Variants could send cases soaring

That's not to say the current trends are less worrisome. Vaccinating the most vulnerable drives down hospitalizations and deaths, but it's important to note that less severe cases are not entirely harmless, Cash-Goldwasser points out. “Even in a mild infection, there is a risk of long COVID or some of these complications that we hear about.”

"Long COVID” is the term coined to describe lingering symptoms — fatigue, headaches, brain fog and shortness of breath, to name a few — that can persist weeks, sometimes months, after a coronavirus infection. A report from the Centers for Disease Control and Prevention (CDC) found that as many as 35 percent of people with mild cases of COVID-19 still felt its effects weeks after testing positive for the virus.

One difference at this stage in the pandemic that could drive up case counts, even as more Americans get vaccinated, is the continued spread of new virus variants, some of which are more contagious and potentially more lethal. CDC Director Rochelle Walensky recently announced that the B.1.1.7. variant, first identified in the United Kingdom, is “now the most common lineage circulating in the United States.” So far more than 16,000 reported COVID-19 cases have been caused by this variant, and spikes are occurring in a number of states, including Michigan, Minnesota, Florida, Colorado, California and Massachusetts, CDC data show.


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Other variants are circulating in the U.S., and more could emerge. But there are ways to protect yourself from these concerning strains, and that's by following the same public health guidance that experts have been promoting all along: Wear a mask in public, keep a safe distance from others, wash your hands often and avoid crowded and poorly ventilated spaces. Health leaders are also encouraging people to get vaccinated when it's their turn.

"This is a good reminder to follow those infection prevention efforts as we work to vaccinate people,” says Saskia Popescu, an infectious disease epidemiologist and assistant professor at George Mason University's Schar School of Policy and Government.

Pandemic fatigue threatens progress

Another factor that could determine whether current trends continue to climb is pandemic fatigue. The combination of a year of restrictions and the growing availability of vaccines is leading some to “let their guards down and socialize more and do more things,” Cash-Goldwasser says.

But doing so could result in devastating consequences, and health experts are pleading for Americans to stay the course. In an April 7 press briefing, Andy Slavitt, White House senior adviser for COVID-19 response, said “better days are on the horizon,” and even predicted that “a more normal Fourth of July holiday is within reach.” But he warned that all of the progress that has been made can be reversed if the public lets down its guard.

"We need to keep being careful, and we need to get shots into arms. And if people get vaccinated as soon as they possibly can and continue to practice these measures, hopefully we will be able to keep things under better control and not see a surge,” Cash-Goldwasser says. 

Rachel Nania joined AARP as a health and medicine writer in 2019 after spending several years as a radio reporter and editor in Washington, D.C. She is the recipient of a 2018 Gracie Award and a 2019 regional Edward R. Murrow Award, and participated in a 2019 dementia fellowship with the National Press Foundation.

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